Provider Demographics
NPI:1558031161
Name:ROZZA, JACQUELINE BEAUPRE (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BEAUPRE
Last Name:ROZZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FRESH BROOK LN
Mailing Address - Street 2:
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-8156
Mailing Address - Country:US
Mailing Address - Phone:508-221-5497
Mailing Address - Fax:
Practice Address - Street 1:20 FRESH BROOK LN
Practice Address - Street 2:
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667-8156
Practice Address - Country:US
Practice Address - Phone:508-221-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA226215163W00000X
NV226215163W00000X
MA226215163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse